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Palliative cancer care - cough - Management
What should I look for on examination?

  • Examine the person to help determine the underlying cause of the cough.
  • Assess the effectiveness of the cough, and whether it is dry, moist, productive, or non-productive.
Clarification / Additional information
  • Examination findings that may suggest a specific diagnosis include [Munro, 1995]:
    • Decreased chest wall movement — lung collapse, pleural effusion.
    • Percussion note — dull on the side of the chest affected by lung collapse, stony dull on the side of pleural effusion.
    • Breath sounds — bronchial or 'blowing' quality over areas of consolidation.
    • Wheeze/stridor — endobronchial tumour.
    • Crepitations — exudate in the bronchioles (e.g. infection, heart failure).
  • Assess respiratory rate and effort. If dyspnoea is the predominant symptom, see the CKS topic on Palliative cancer care - dyspnoea.
  • Ask the person to cough to assess the effectiveness. (i.e. Is the cough powerful enough to expectorate secretions?)
  • Factors leading to ineffective cough in people with cancer include [Twycross and Wilcock, 2001; Doyle et al, 2004]:
    • Muscle factors — general debility, weakness of respiratory or abdominal muscles, neurological problems, decreased level of consciousness.
    • Airway factors — non-compressible airway (tumour or stent insertion), vocal cord paralysis.
    • Mucus factors — reduction of water content of mucus (e.g. reduced fluid intake, drug effects).
    • Mucociliary factors — impaired mucociliary function (e.g. smoking, infection).
  • Treatment for cough is usually effective if the cause is identified [Doyle et al, 2004].
Basis for recommendation

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